Gau Laurence, Ribeiro Mathieu, Pereira Bruno, Poirot Karine, Dupré Aurélien, Pezet Denis, Gagnière Johan
Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
Biostatistics, Direction de La Recherche Clinique et de L'Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
Eur J Surg Oncol. 2021 Nov;47(11):2722-2733. doi: 10.1016/j.ejso.2021.05.039. Epub 2021 May 31.
Data regarding clinical outcomes of patients undergoing hepatic resection for BRAF-mutated colorectal liver metastases (CRLM) are scarce. Most of the studies report an impaired median overall survival (OS) in BRAF-mutated patients, but controversial Results regarding both recurrence-free survival (RFS) and recurrence patterns. The purpose of this updated meta-analysis was to better precise the impact of BRAF mutations on clinical outcomes following liver surgery for CRLM study, especially on recurrence.
A systematic literature review was performed to identify articles reporting clinical outcomes including both OS and RFS, recurrence patterns, and clinicopathological details of patients who underwent complete liver resection for CRLM, stratified according to BRAF mutational status.
Thirteen retrospective studies, including 5192 patients, met the inclusion criteria. The analysis revealed that both OS (OR = 1.981; 95% CI = [1.613-2.432]) and RFS (OR = 1.49; 95% CI [1.01-2.21]) were impaired following liver surgery for CRLM in BRAF-mutated patients. Risks of both hepatic (OR = 0.42; 95% CI [0.18-0.98]) and extrahepatic recurrences (OR = 0.53; 95% CI [0.33-0.83] were significantly higher in BRAF-mutated patients. These patients tended to have higher rates of right-sided colon primary tumors, primary positive lymph nodes, and multiple CRLM.
This meta-analysis confirms that BRAF mutations impair both OS and RFS following liver surgery. Therefore, BRAF mutational status should probably be included in further prognostic scores for the assessment of the expected clinical outcomes following surgery for CRLM.
关于接受肝切除治疗BRAF突变型结直肠癌肝转移（CRLM）患者的临床结局数据匮乏。大多数研究报告BRAF突变患者的中位总生存期（OS）受损，但关于无复发生存期（RFS）和复发模式的结果存在争议。这项更新的荟萃分析的目的是更精确地确定BRAF突变对CRLM肝切除术后临床结局的影响，尤其是对复发的影响。
进行系统的文献综述，以识别报告临床结局（包括OS和RFS）、复发模式以及接受CRLM完全肝切除患者的临床病理细节的文章，并根据BRAF突变状态进行分层。
13项回顾性研究，共5192例患者，符合纳入标准。分析显示，BRAF突变的CRLM患者肝切除术后OS（OR = 1.981；95%CI = [1.613 - 2.432]）和RFS（OR = 1.49；95%CI [1.01 - 2.21]）均受损。BRAF突变患者肝内复发（OR = 0.42；95%CI [0.18 - 0.98]）和肝外复发（OR = 0.53；95%CI [0.33 - 0.83]）的风险均显著更高。这些患者右侧结肠原发肿瘤、原发淋巴结阳性和多发CRLM的发生率往往更高。
这项荟萃分析证实BRAF突变会损害肝切除术后的OS和RFS。因此，BRAF突变状态可能应纳入进一步的预后评分中，以评估CRLM手术后的预期临床结局。
